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2.
Disclosures
 This ongoing chest X-ray interpretation series is proudly sponsored by the
Emergency Medicine Residency Program at Carolinas Medical Center.
 The goal is to promote widespread mastery of CXR interpretation.
 There is no personal health information [PHI] within, and ages have been
changed to protect patient confidentiality.

3.
Process
 Many are providing cases and these slides are shared with all contributors.
 Contributors from many CMC/LCH departments, and now from EM
colleagues in Brazil, Chile and Tanzania.
 Cases submitted this month will be distributed next month.
 When reviewing the presentation, the 1st image will show a chest X-ray
without identifiers and the 2nd image will reveal the diagnosis.

5.
3 month old female with history
of congenital heart defect s/p
repair who presented to the ED
with hypoxia and increased
work of breathing .
Her CXR is consistent with
which congenital heart defect?

6.
Heart with wooden shoe shape
Oligohemia (reduction of blood flow
in the peripheral circulation
Pulmonary artery
segment concavityEnlarged aorta
Tetralogy of Fallot
for more information see
last month’s feature on
TOF

7.
3 year old female with past
medical history of congenital
diaphragmatic hernia s/p
repair who presents to the ED
with increased work of
breathing

9.
When compared to multiple previous CXRs, this is
stable and consistent with a repaired congenital
diaphragmatic hernia.
2017 2019

10.
2017 2019
Always compare
with previous CXR!
When compared to multiple previous CXRs, this is
stable and consistent with a repaired congenital
diaphragmatic hernia.

11.
Congenital Diaphragmatic Hernia
• 1 in every 3000 live births
• Predominantly male infants
• Can be isolated or associated with a
number of genetic syndromes
• Abdominal contents herniate through the
diaphragmatic defect and cause pulmonary
hypoplasia
• Most often presents with respiratory
distress at or soon after birth
• CXR findings
• Air filled and fluid filled loops of bowel in the
thorax
• Cardiac silhouette shifted to the opposite
hemithorax
https://pedemmorsels.com/congenital-diaphragmatic-hernia/
https://eapsa.org/parents/learn-about-a-condition/a-e/congenital-
diaphragmatic-hernia/

12.
12 year old female with no
past medical history presents
with back and left shoulder
pain after a rollover motor
vehicle crash.

22.
What’s with these kids?
For the next section, we will review a series of cases & images with a
unifying diagnosis. Try to identify the similarities and come up with the
diagnosis! After each series of cases, we will discuss the
pathophysiology and imaging characteristics of the diagnosis.
These images and cases have been graciously shared with us from our
colleagues in the Pediatric Cardiovascular Surgery Division. We thank
everyone for your continued support of this project!

23.
Female neonate with known
congenital abnormality based
on antenatal screening and
IUGR born at 39 weeks and
transferred to the NICU for
close monitoring
Physical exam notable for low
pitched 2/6 systolic murmur at
the left sternal border.

24.
Female neonate with known
congenital abnormality based on
antenatal screening and IUGR born
at 37 weeks and transferred to the
NICU for close monitoring.
Physical exam notable for a constant
systolic ejection click and 2/6, mildly
harsh systolic ejection murmur heard best
at the cardiac base.